Two cephalic screws combined compression proximal-femur intramedullary nailing internal fixation versus long-stemmed cemented bipolar hemiarthroplasty for treating intertrochanteric fractures in Patients 75 Years and Older: a retrospective study

Background: As the population continues to age, the occurrence of intertrochanteric femoral fractures (IFF) has been steadily increasing. Presently, the primary surgical treatment modality for this condition is intramedullary nailing fixation. However, primary cemented hemiarthroplasty is being considered a viable treatment option. The main aims of this investigation were to evaluate and draw comparisons between the clinical outcomes, ambulatory ability, overall survival, and all-cause mortality between two cephalic screws combined compression proximal-femur intramedullary nailing internal fixation (IF) and long-stemmed cemented bipolar hemiarthroplasty (LCHA) treatment of IFF in patients aged 75 years and older. The secondary objective was investigating relative independent risk factors contributing to postoperative all-cause mortality. Methods: A retrospective analysis was conducted on 251 elderly patients (≥ 75 years) with IFF who underwent IF or LCHA between January 2018 and October 2022. We employed generalized estimating equations along with univariate and multivariate analyses to examine the impact of various surgical interventions and other pertinent factors on postoperative ambulatory ability and all-cause mortality outcomes. Associations between sex, age, number of comorbidities, aspartate aminotransferase (AST) levels, total blood transfusions, and mortality were analysed using Cox proportional hazards models. Results: The analysis included a cohort of 120 patients from the IF group and 121 patients from the LCHA group. Statistically significant differences were not observed in the clinical outcomes, ambulatory ability, overall survival, or all-cause mortality after surgical treatment between the groups receiving IF and LCHA (p > 0.05).Nevertheless, among patients (age ≥ 85 years),the IF group demonstrated a lower rate of all-cause mortality compared to the LCHA group (p < 0.05). The older the patient, the greater the number of preoperative comorbidities and amount of perioperative transfusion; a lower preoperative AST level was associated with a higher risk of postoperative death (p < 0.05). Conclusions: The results imply that the choice of IF or LCHA treatment for elderly patients with IFF aged 75 years or older may need to be tailored to the number of preoperative comorbidities, sex, age, preoperative AST level, and cost-effectiveness.